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Post some patient specific/clinical thoughts after this short review article.
Cheers
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Interesting article. Serves as a good reminder that tendinopathies can take longer to heal due to the poorly vascularized nature of the tissue. I found it interesting that neural and vascular tissues can infiltrate injured areas of tendons. The article stated that this ingrowth of neurovascular tissue can be halted with exercise due to a degree of neuronal plasticity. To me, that reinforces the need for tendon loading of varying degrees in patients with tendon pathology. It was striking that collagen synthesis begins immediately following exercise.
Additionally, it was interesting to see the emphasis on the proprioceptive and nociceptive nerve endings in knee ligaments. This further pushes the need for proprioceptive interventions in our patients s/p ACL reconstruction in addition to traditional strengthening exercises.
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The author states that the female gender is an intrinsic factor associated with tendon degradation rather than adaptation. I can’t think of any rationale behind this. Can anyone enlighten me?
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I did find this to be a helpful review of tendon and ligament anatomy and physical properties.
I saw a new patient today with achilles tendinopathy and retrocalcaneal bursitis, 50 yo female, works in housekeeping. She was placed in a walking boot for 6 weeks and then issued a heel lift and a Rx for PT 2 days ago. She has been limping around for 2 days, loading her lateral column and avoiding dorsiflexion. I can’t think of the rationale for the 6 weeks in a boot rather than PT during that time period. -
This article was a great A and P review on ligaments and tendons. I thought it was great to give the normal values of tendon loading vs the amount of load it takes for total tendon failure. Although we went over it in classes, it was nice to see it spelt out the physiologic mechanism of the changes that occur to the tissues when a tendon is injured and attempting to heal. Above all, I think this is a great patient education source to help explain realistic healing time lines to patients. This past week I was asked by a patient with gluteal tendinopathy how long it takes for her condition to get better. I definitely stumbled and was not able to give her a confident answer. After reading this article I feel like I will better be prepared to explain expected time frame and lay out realistic tendon healing expectations early in treatment.
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I agree with Tyler, I think the information regarding neural ingrowth into injured tendons was very interesting and reinforces the concept of prescribing isometrics in painful tendinopathies. I often utilize isometrics with these patients, but it was nice to get a little more of the pathophys behind why this concept works. I also thought the mechanism for ligaments accepting load was interesting in regards to elongation prior to failure. This article is also a good reminder of a great educational tidbit for patients regarding tendon healing, that although the remodeling phase begins within 6-8 weeks, tendons can take 1-2 years to complete their remodeling.
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hey Justin, this is what i could find…”Gender has also been shown to be a significant intrinsic contributor to development of degeneration instead of remodeling, with tendons from females exhibiting decreased collagen synthesis rate in response to acute exercise and dampened hypertrophy in response to habitual exercise. However, while correlations between incidence of injury or retear and these contributing factors have been identified, the mechanisms by which these factors alter the biological environment or govern the mechanosensitivity of the responding cells remains unknown.”
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